Insights into Mentorship for Endocrinologists

Abstract

Context:

Effective mentorship is considered a prerequisite for success during medical training and an ensuing professional career in academic medicine. The Endocrine Society established sessions on mentorship at the Trainee Day during several annual meetings. These requests motivated a group of endocrinologists at the University of Virginia to assess prior literature on mentorship and collect opinions on the importance of the various characteristics of mentorship from endocrinologists, general faculty, and trainees. This information served as the basis for in-depth reflection and discussions on mentorship.

Objective:

The goal was to identify and prioritize the quintessential elements involved in mentorship and to reach practical conclusions that would be beneficial to academic endocrinologists.

Commentary:

A multigenerational mentorship tree emphasizes that successful mentors can influence generations of mentees and that this represents a multiplier effect. The authors propose that trainees who are informed about the most important characteristics of an effective mentor can make better choices of a mentor. On the other hand, mentors can best define expectations when mentees know what to expect from a mentor, based on key characteristics.

Conclusions:

Similarities and differences in expectation about mentorship can be leveraged for better communication between mentor and mentee and for the development of stage-appropriate educational curricula on academic mentorship.

Effective mentorship is considered a prerequisite for success during medical training and an ensuing professional career in academic medicine. Because of the importance of this issue, The Endocrine Society had asked one of the authors (R.J.S.) to conduct sessions on mentorship at the Trainee Day during several annual meetings. These requests motivated an overall assessment of various aspects of mentorship. The goal was to identify the quintessential elements involved in mentorship and to reach practical conclusions that would be beneficial to academic endocrinologists. To achieve this goal, a multistep iterative process was undertaken, including literature review, formation of a discussion group involving the authors, and questionnaire development, and implementation. This commentary, while not a scientific study, shares the insights gained from this process and suggests practical steps to enhance the mentorship process.

Definition: The term “mentor” is defined in the Oxford English dictionary as “a person who acts as guide and adviser to another person, especially one who is younger and less experienced.” The term “mentor” is derived from the name Mentor, the man described by Homer in the Odyssey who served as the tutor for Telemachus, the son of Odysseus.

Example of Effective Mentorship

Effective mentors provide prismatic examples of their influence on mentees as well as their impact on future generations of trainees. An excellent example of mentorship was provided by Dr. C. Alvin Paulsen, a leader in the field of male reproductive endocrinology, who influenced several generations of trainees in this field before his passing. The “Paulsen Genetic Tree” (Fig. 1) illustrates the long-term impact of mentorship that extends well beyond one's influence on individual mentees. This figure shows that the influence of a successful mentor on training, academic leadership, and clinical care can extend over several generations. The effort as a mentor can be enhanced severalfold through a generational effect. Cognizance of this multiplier effect provides a strong motivation for one to devote a major effort to mentoring.

Fig. 1.

The first and second generation mentees of C. A. Paulsen are shown as on a genetic diagram. The symbols represent those individuals who were involved in academic medicine and research and who went on to become division heads or department chairs. The third and fourth generations of trainees have been identified but are not shown.

Distinction between Mentorship and Stewardship

During the authors' process of obtaining advice from multiple sources, William Alexander (personal communication), a Wharton School of Business professor, pointed out the important differences between stewardship and mentorship. Stewardship, as defined in the Merriam-Webster dictionary, represents “the conducting, supervising, or managing of something; especially: the careful and responsible management of something entrusted to one's care.” In essence, stewardship is primarily directed toward groups, not individuals, and is the primary role of department chairs, division chiefs, and laboratory directors. Mentors, on the other hand, focus on individual needs and career development. Importantly, conflicts of interest may arise when stewards also act as mentors. As an example, a department chair may advise a department member to remain at his/her own institution when acting as a steward but, when acting as a mentor, would advise that member to go to another institution if greater opportunity existed elsewhere.

Literature on Mentorship

An extensive review of the medical literature identified several characteristics of mentorship (Supplemental Tables 1–3, published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org) (1–30 and http://www.hhmi.org/resources/labmanagement/downloads/moves2_ch5.pdf, pages 97–111). Three were considered to be indispensable: honesty, trustworthiness, and high moral standards. However, it became apparent while reviewing the literature that minimal emphasis had been placed on the relative importance of each individual characteristic, and no studies attempted to prioritize among the various characteristics.

Prioritizing Mentorship Qualities

Questionnaire

To prioritize different mentor characteristics, a questionnaire was developed (see Supplemental Material for specific details) and sent to faculty and trainee members of the Endocrinology Division and to general faculty members at the University of Virginia. Forty-four members of the Endocrinology Division (73%) and 194 general faculty members (15%) responded, resulting in a total of 238 responses.

Ranking of mentorship qualities

The questionnaire results from the 238 responders prioritized the perceived value of mentorship characteristics (Table 1), ranking from the highest downward using Likert scores. The top five characteristics included provision of constructive criticism, provision of support to foster the intellectual independence of mentee, communication skills, motivation of mentor, and commitment to the time needed for mentoring. Several characteristics were considered to be of low priority, including compassion/empathy, ability to form a friendly relationship with mentee, and ability to serve as counselor for personal issues.

Table 1.

Prioritization of mentorship characteristics

Rank	Score	Name of characteristic
1	97.5	Ability of mentor to provide feedback and constructive criticism to mentee
2	95.7	Ability of mentor to foster and support intellectual independence of mentee
3	95.3	Communication skills
4	94.5	Commitment to the idea of mentoring
5	94.5	Commitment to time required for successful mentoring
6	91.5	Selflessness of mentor in giving appropriate credit to mentee
7	91.1	Accessibility
8	91.1	Mentor as role model who leads by example
9	89	Insight into qualities and skills of mentee
10	88.5	Ability of mentor to advise and guide mentee on grant opportunities, promotion and tenure, etc.
11	87.2	Enthusiasm about research (fire in the gut)
12	85.5	Ability to network in the scientific community to provide opportunities for mentee
13	85.2	Ability of mentor to guide mentee in the identification of testable hypotheses and doable project
14	84.9	Selflessness (has best interests of mentee at heart)
15	84.3	Ability to collaborate with others
16	84.1	Knowledge of ideal career pathway components/strategies to develop plan leading to independence of mentee
17	81.3	Scientific vision
18	79.8	Energy
19	77.6	Ability of mentor to motivate mentee
20	76.6	Ability to provide structure and support
21	76.4	Institutional selflessness regarding counseling mentee on continuing work at mentee's own institution or another
22	76.3	Experience in training
23	73.7	Scientific reputation/respect of mentor by scientific community
24	69.4	Potential for interpersonal chemistry between mentor and mentee
25	68.4	Compassion/empathy
26	66.4	Track record in training (successful careers of former mentees)
27	55.3	Ability to form a friendly relationship with mentee
28	52.6	Ability and willingness to teach specific aspects of mentee's project (lab techniques, data analysis, scientific concepts)
29	22.6	Ability to serve as counselor for personal issues

Score indicates the percentage of responders who ranked a characteristic in the highest (i.e. as 5) or next highest (i.e. as 4) on the 1–5 Likert scale.

Comparison of priorities across specific groups

For the majority of characteristics, no significant differences were found among the various subgroups of responders. However, senior faculty members judged five of the characteristics to be more important and two to be less important than did their more junior counterparts (shown in Fig. 2). An interesting aspect was that students rated the majority of aspects of mentorship lower on the Likert scale of importance than all of the other subgroups. We considered that this probably reflected their lack of experience in interacting with mentors. Gender influenced perceptions regarding mentorship very little, but there were two exceptions. Women considered the ability to collaborate as more important than did men. The “ability of the mentor to guide mentees in the identification of testable hypotheses and doable project” was rated more highly by men.

Fig. 2.

Responses of trainees compared with junior and senior faculty. The full description of categories include: scientific vision, enthusiasm about research, selflessness of mentor in giving credit to mentee, ability of mentor to provide feedback and constructive criticism, scientific reputation/respect by scientific community, ability and willingness to teach specific aspects of mentee's project, and ability to form relationship with mentee. Statistics represent Cochran-Armitage trend analyses. *, P = 0.05; **, P = 0.02; ***, P = 0.001.

Committee Deliberations on Mentorship

Further insight into mentorship was derived from the deliberations of a medical school committee at the University of Virginia charged with examining the development of clinical investigators (see Supplemental Material for details). As shown in Table 2, the committee recommended that mentorship should involve a template with three main components: 1) a formal evaluation and decision-making process; 2) a required knowledge base that the mentor must attain and that is considered essential for providing effective advice; and 3) a specific schedule of formal meetings as well as the provision for ad hoc meetings. These recommendations, and the specifics detailed in Table 2, serve to identify elements that the mentor as well as mentee should understand before entering into a special mentor/mentee relationship. The authors note that other opinions might hold that meetings between mentors and mentees might optimally be held weekly or even several times weekly and that that the ideas identified in Table 2 do not represent concepts tested in a randomized trial but are the collective suggestions of the committee.

Table 2.

Committee recommendations on mentorship

Expectations

Interactions between mentor and mentee will be collegial, cooperative, and coproductive, and all written approval processes by the mentor are designed to create a framework to facilitate the mentorship relationship but not provide unnecessary paperwork or roadblocks

Formal evaluation and decision-making process

Writing yearly written evaluations of mentee to assess progress of mentee in research

Reviewing a written research plan by mentee at yearly intervals and providing critical judgment regarding its strengths and weaknesses

Helping to prepare, reviewing, and approving a yearly budget for expenditure of mentee's start-up funds

Assisting in all stages of grant preparation, and reviewing/approving all grants prior to submission

Knowledge required for provision of advice

Being responsible for knowing the current status of all applicable career development awards (e.g. National Research Service Awards) to allow provision of advice about submissions

Being responsible for knowing the criteria for promotion and tenure in the mentor's institution

Being cognizant of the need to allow a mentee to become recognized as independent and for general guidelines for inclusion of mentor as coauthor on mentee's publications

Being cognizant of requirements for membership in prestigious national societies, such as the American Society for Clinical Investigation, to allow effective advice about strategies conducive to later membership

Formal meetings

Holding yearly meetings to review the written progress report on research

Holding ad hoc meetings at least bimonthly to review research results and plans

Practical Considerations

After examining these various aspects of mentorship, we would consider several issues to be worth understanding and implementing. Effective mentorship is a prerequisite for achievement in any scientific field and is equally applicable to the field of endocrinology (5, 9–11, 16–19, 24, and www.aamc.org/postdoccompact). Trainees evaluating and choosing a mentor would benefit from knowing the most important characteristics required for mentors to guide and support their mentees. The ranked list provided in Table 1 provides a template upon which to judge a prospective mentor. Mentors and mentees should recognize that perceptions about mentorship change with increasing experience. Senior mentors judge scientific vision, enthusiasm for research, and scientific reputation/respect of mentor by scientific community as more important than do younger mentees. In addition, these mentors also judge other characteristics to be less important than their younger peers, such as ability to form friendly relationship with mentees, selflessness of mentor in giving appropriate credit to mentee, and ability to teach. Understanding the differences in expectations as a function of academic rank may be helpful to both mentor and mentee in developing and communicating about a productive and mutually rewarding research relationship.

It may be helpful to students to recognize that their perceptions about mentorship might be influenced by their lack of experience interacting with research mentors. For example, students undervalued most characteristics of mentorship that were valued by more advanced trainees and by faculty, and they viewed mentors primarily as teachers. Recognizing this fact, we suggest that a formal educational process about the goals of academic mentorship would empower the student to make informed decisions in selection of a research mentor. Such a process would instruct students what to look for in a mentor and why these characteristics are important. Finally, mentors and mentees should understand the important distinction between stewardship and mentorship. An important corollary would be that mentees should consider choosing at least one mentor without coexisting stewardship responsibilities.

Limitations

Critical constraints compromise the effectiveness of the mentor/mentee relationship in the current milieu with respect to the successes emphasized by the genetic tree (Fig. 1). Mentees have incurred large debts. Marked reductions in National Institutes of Health support for trainees limit their chances for success in obtaining funding. Fiscal support for specific training mechanisms such as K awards is diminishing. Excellent mentees and mentors will fail to propagate themselves in the absence of grant support.

Additional issues could have been added to the questionnaire but were not considered. These include the willingness of a mentor to allow the mentee to establish their own areas of research, an issue that can be called “generosity of turf,” a key to success. It was also not considered whether mentors be of the same gender or ethnicity as the mentees. Finally, we recognize limitations in our data collection process. Although 73% of endocrinologists responded to the questionnaire, only 15% of the general faculty did so. A separate analysis of responses by endocrinologists and the entire group did not differ greatly (Supplemental Table 4), which provided us a measure of confidence in the results.

Summary

The authors propose that trainees who are informed about the most important characteristics of an effective mentor can make better choices of a mentor. On the other hand, mentors can best define expectations when mentees know what to expect from a mentor based on key characteristics. These similarities and differences in expectation can be leveraged for better communication between mentor and mentee and for the development of stage-appropriate educational curricula on academic mentorship.